Provider Demographics
NPI:1790383123
Name:PHILIP, SYBIL (PHARM D)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:PHILIP
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5807
Mailing Address - Country:US
Mailing Address - Phone:936-890-5060
Mailing Address - Fax:
Practice Address - Street 1:12605 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5807
Practice Address - Country:US
Practice Address - Phone:936-890-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist